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by Burdon R

Thesis

Year

1996

City

Sydney, New South Wales

University

University of New South Wales

Thesis type

Master of Public Health

Abstract

There has been little research examining the hospital admissions of urban Aboriginal children. The contribution of readmissions to total hospital admissions and the follow up of urban Aboriginal children once discharged from hospital has been particularly poorly documented.

Tharawal Aboriginal Corporation was established in 1975 to provide health and social services to a rapidly growing Aboriginal population in outer South Western Sydney. The Aboriginal population of outer South Western Sydney was estimated at 2,505 in 1991 and 86% of these people live in Campbelltown. The Campbelltown hospital is the only paediatric inpatient service in outer South Western Sydney.

Between January 1 1988 and June 30 1994, 148 Aboriginal children had 220 admissions to Campbelltown hospital. These children were identified in the following way:

102 children had a medical file at Tharawal Aboriginal Medical Centre;

20 children had been coded "00" for Aboriginal on admission to hospital; and

26 children had a medical file at Tharawal and had been coded "00" on admission

Thus, only 26 children of 128 children with a file at Tharawal (20.3%) had been correctly identified and coded for Aboriginality on admission to hospital. This suggests that a disturbingly low proportion of Aboriginal children are accurately identified on admission to Campbelltown hospital.

The three most common admission diagnoses were Asthma (17.3%), Bronchiolitis (10.9%) and Gastroenteritis (5.5%). Vaccine preventable diseases made up 4.1% of the total number of admissions. Immunisation status, where recorded, was found to be more than two months behind the appropriate schedule in 43.6% of admissions. Weight had been plotted on a centile chart in 69.5% of admissions and was less than the third centile in 13.1% of recorded admissions while height/length had only been plotted in 35% of admissions. Follow up arrangements were documented in 80.5% of admissions but follow up only occurred in a disturbingly low 24.9% of recorded admissions. The median length of hospital stay was two days and the median age on admission was 20 months with 37% of admissions being under 12 months of age.

One hundred and ten children had a single admission and 38 children were responsible for the remaining 110 admissions. In comparison to children who only had a single admission, children who had multiple admissions to hospital were, on their first admission to hospital, more likely to be less than 12 months of age, more likely to be admitted for asthma or bronchiolitis, more likely to weigh less than the fifth centile and were more likely to be unwell for three or more days prior to admission.

There were no significant associations between whether follow up occurred and any demographic or admission variables. However, it did appear that children who had been admitted with a respiratory illness or a surgical condition, children who were less than the fifth centile for weight and children who were up to date with immunisations had a slightly greater tendency to attend follow up.

An improvement in the accurate coding of Aboriginality on admission to hospital plus improved documentation of height, weight and immunisation status would allow the identification of health priorities for Aboriginal children in Campbelltown. Readmissions of Aboriginal children may be prevented by improving predischarge assessment and better coordinated post discharge follow up. A formal structure enabling coordinated discharge care between the hospital and the medical staff at Tharawal Aboriginal Corporation could prevent those Aboriginal children, particularly those children who are readmitted within a month of discharge, from readmission to hospital.